Is it Irritable Bowel Syndrome?
At Ignite, as a gut health dietitian, I primarily practice in functional gut disorders and other gut diseases. IBS is very near and dear to my heart. I have suffered from IBS and has seen the impact nutrition and a holistic approach to IBS management can make. As such, I’m a huge advocate that everyone with an IBS diagnosis should be involved with a registered dietitian.
Interestingly enough, many of my clients come to me ‘kinda/sorta’ diagnosed with IBS. They aren’t very confident in their diagnosis, or what it means. They’ve had all other gut conditions ruled out. And often they’re left with a ‘well I guess you have IBS’ diagnosis. And they are occasionally advised to eat more fibre.
There appears to be a lack of confidence in the medical community as to how to best manage these patients¹. It’s no wonder – I really believe that those with IBS diagnoses require individualized nutrition advice to manage their IBS symptoms. Each patient is different. Therefore, each patient does best when receiving practical nutrition advice from a registered dietitian trained in IBS management.
Common IBS questions:
- How do they diagnose irritable bowel syndrome?
- Why is there stigma around an IBS diagnosis?
- Why is IBS under-treated?
- How to treat IBS?
How do they diagnose irritable bowel syndrome?
IBS used to be a diagnosis of exclusion. Meaning other conditions, like celiac, gastrointestinal viruses/bugs, and inflammatory bowel disease are ruled out or not suspected. Now, we’ve moved towards ruling these out, if suspected, followed by confirmation of diagnostic criteria.
I think people struggle so much with their diagnosis because there isn’t a specific test that says ‘yes! That’s it! This is exactly what you have’ – but rather is based on symptomatology.
IBS diagnostic criteria is defined as recurrent abdominal pain or discomfort for at least 3 days per month for the last 3 months. With at least TWO of the following:
- Improvement of symptoms with defecation
- Onset associated with a change in the frequency of stool
- Onset associated with a change in the form/appearance of stool
The diagnostic criteria must be fulfilled for the last 3 months. With symptom onset at least 6 months prior to diagnosis².
To put it in lay-man’s terms – if you have abdominal pain or discomfort 3 days per month, for 3 months in a row, along side at least 2 of the 3 of the criteria (improvement in symptoms with defecation, pain/discomfort is associated with a change in the number of bowel movements, or the consistency of those bowel movements) – then there could be cause for an IBS diagnosis.
Practical Takeaways on IBS Diagnosis:
- Suffering from abdominal pain and changes in bowel habits? See your family doctor.
- Don’t be afraid to talk about poop! Tell your doctor how often your having pain. Also, how regularly you’re going to the bathroom, and what the consistency of your stool is. Don’t forget to mention if you’re experiencing bloating, distention, or urgency. (My clients often describe distention as a ‘5 months pregnant’ belly).
- If you have blood, mucous, or clay coloured stools, be sure to tell your family physician. As it may be cause for other tests.
- The only person qualified to diagnose IBS is your physician. Before starting any treatment plan, having a diagnosis is key.
Why is there stigma around an IBS diagnosis?
As with any poorly understood condition – IBS seems to have developed a stigma. I’ve heard story after story of those with IBS being told ‘it’s all in your head’. Or, ‘if you just did (insert small intervention here) your IBS symptoms would be fine’. It breaks my heart, and has a huge impact on how those with an IBS diagnosis feel about their disease. That it needs to be kept a secret. That it is somehow less valid, and that people don’t take their IBS symptoms seriously.
At this point – we have a good understanding that IBS is complex. It involves how our brain and gut talk to one another. That the bacteria in our gut play a role, and that there are interventions to help manage IBS symptoms.
IBS isn’t just something you have to learn to live with.
There are ways we can help to end the stigma around those who have IBS. This includes: understanding that there are treatment options, that we’re still learning about how best to manage IBS symptoms, and that IBS is a very real disease .
Did you know, Canada has one of the highest rates of IBS in the world? 13-20% of the population suffer from IBS, with time to diagnosis being over 6 years. By ending stigma, more people can find solutions and manage their IBS symptoms sooner.
Practical Takeaways on Stigma Around IBS
- Everyone’s experience with IBS symptoms is different – respect their story
- We don’t KNOW everything about IBS – far from it! We’re only now starting to understand how the brain and the gut communicate. How the gut microbiome plays a role, and how to best manage IBS symptoms
- IBS isn’t just impacted by psychological conditions. Rather, we see links in epigenetics. How the gut bacteria talk to the brain rather than just how to the brain talks to the gut. History of illness, stress, and so many other things as well.
Why is IBS under-treated?
Well, this one is complicated. So much of what we’ve learned about IBS has only just occurred in the past 10 years. We’ve only just begun to understand how the gut microbiome, carbohydrate malabsorption, and visceral hypersensitivity (how we perceive digestive sensations) contribute to IBS symptoms. In research terms – our understanding of IBS is still relatively new!
As such, awareness about the different treatment options are not always well-known.
As a registered dietitian that specializes in gut health – I am often the one spending the most time with you. Where I think we have huge gaps is our ability to rely on a ‘team approach’. At Ignite, I find it’s very important to bring other health professionals to the table. Whether it’s your family physician, naturopath, psychologist, or other health professionals. For IBS management, a team approach is needed. To ensure all those with an IBS diagnosis get appropriate treatment.
Practical Takeaways on Under-Treatment of IBS
Awareness and understanding of the treatment options is the biggest gap! Working with and relying upon experts to guide care, like IBS dietitians, can help to coordinate treatment plans.
How to Treat IBS
As a registered dietitian, providing nutrition counselling that is rooted in evidence is so important. I always take a ‘food-first’ approach to managing my patients care. Working with them on IBS symptom management, practical implementation of nutrition recommendations, and most importantly making sure there is no risk of harm.
Tips on How to Manage Irritable Bowel Syndrome
At the Ignite offices, each clients’ nutrition intervention is based on their IBS symptoms. My practice is grounded with 4 pillars for gut health.
1. The low FODMAP diet for IBS management
The low FODMAP diet is for IBS patients. It involves removing specific carbohydrates that are known to be more difficult to digest or are malabsorbed. I always explain to my clients – the low FODMAP diet is like a ‘bandaid’ solution. It helps to manage your IBS symptoms, and determine which foods may cause triggers. However, it’s not safe to stay on the low FODMAP diet long term. As many FODMAP’s are important for gut health, and feed good bacteria. We eliminate FODMAPs, determine triggers, and focus on improving gut health. While including a balance of these foods to your upper most tolerable level
2. Stress management and mindfulness for IBS management
Mindfulness is the corner-stone of shifting the conversation between your brain and your gut, and how you perceive IBS symptoms. Working to manage stress and anxiety through mindfulness plays a role in how we perceive our gut symptoms. It may positively influence our gut microbiome. It will also help to gain awareness and understanding of situations that may exacerbate our IBS symptoms.
4. Functional foods for IBS management
As a ‘food first dietitian’, I really see the value in using food to manage IBS symptoms. So, when it comes to IBS symptoms, one of my go-to options is peppermint. Peppermint has anti-microbial and anti-inflammatory actions, and influences how the gut contracts. The trouble with straight up peppermint (tea, etc) is that dosing can be different. Additionally, the muscle relaxing effects acting in the stomach can also trigger reflux.
A product we often use in practice is IBGard. IBGard is a Natural Health Product in Canada. They’ve taken peppermint oil, and put it into a pill form that allows peppermint oil to reach the small intestine. Instead of being released straight into the stomach. This form of delivery ensures that my clients are less likely to get reflux. I use this in two different ways in my practice, depending on the client. Firstly, IBGard is great for those ‘IBS flare ups’ – when you have IBS symptoms you didn’t expect. Research shows that within 2 hours of taking IBGard, over 75% of those with IBS symptoms saw relief.
The second way I use IBGard is before each meal to manage IBS symptoms. Again, evidence supports the use of encapsulated peppermint oil to reduce IBS symptoms long term. By as much as 40%. Without any other nutrition changes. I always suggest formulating a plan with your registered dietitian or physician in regards to the best way to take IBGard3,4.
5. A focus on gut health for IBS management
3 words. Fibre, fibre, fibre. Adequate fibre, and reduction of added sugars is paramount for gut health. While my clients implement the low FODMAP diet, we also focus on adequate fibre. Our team’s meal plans and practical nutrition advice around fibre make implementing this tip common sense, not confusing.
Disclosure: This is a sponsored post. I was compensated for my time in writing this post to share about IBS Awareness Month. While the information conveyed may support clients’ objectives, the opinions expressed are my own and based on current scientific evidence. I do not engage in business with companies whose products or services do not match my personal and professional beliefs.
FAQs about IBS Diagnosis
IBS used to be a diagnosis of exclusion – meaning other conditions, like celiac, gastrointestinal viruses/bugs, and inflammatory bowel disease are ruled out or not suspected. Now, we’ve moved towards ruling these out, if suspected, followed by confirmation of diagnostic criteria.
If you have abdominal pain or discomfort 3 days per month, for 3 months in a row, alongside at least 2 of the following 3 criteria – improvement in symptoms with defecation, pain/discomfort associated with a change in the number of bowel movements, or the consistency of those bowel movements – then there could be cause for an IBS diagnosis.
Although you can’t self-diagnose IBS, if you are suffering from abdominal pain and changes in bowel habits it is important to see your family doctor. The only people qualified to diagnose IBS is your physician or a gastroenterologist.
Just wondering where you can find IBGard in Calgary? I would love to recommend it to my clients. Thanks!
it’s available at most Shopper’s Drug Marts.I believe it’s also available at Rexall. I’m actually so impressed with it – as someone who has quite well controlled IBS – I trialled it as well for a week once and had very impressive improvement in symptoms – absolutely no bloating – compared to the peppermint tea I drink every day which I would still get occasional bloating with.
Now I just use it here and there – clients usually tend to use it for a week or two to start (evidence is 4 weeks continual improvement week over week) – and then titrate back to a dose they find works for them – usually when they anticipate they’ll have symptoms with a meal, etc. There isn’t evidence on the long term safety and use yet – however I would anticipate it to be comparable to any other form of ingesting peppermint.
Hope that helps!